An RWJF Collection

Northwest Patients to Gain Easy Access to Clinicians Notes

April 8, 2014

Portland, Ore.—A unique regional collaboration among nine prominent health systems and medical groups in the Northwest will provide more than one million patients in Oregon and Southwest Washington with electronic access to the notes their providers include in medical records. This marks the first time that OpenNotes, a national movement that urges health-related organizations to adopt open access to clinician notes as a standard of care, has been embraced simultaneously throughout an entire region.

Spurred by the efforts ofthe nonprofit group, We Can Do Better, the health providers that have committed to practicing open notes, are Kaiser Permanente Northwest, Legacy Health, Oregon Health & Science University, Providence Medical Group Oregon, The Portland Clinic, The Vancouver Clinic, Portland VA Medical Center, OCHIN and Salem Health. Each of these groups is already practicing open notes in some form, or intends to do so sometime in 2014 or 2015.

For its part, Kaiser Permanente Northwest begins making clinician notes available to its members across the region starting today. “Now, nearly 500,000 Kaiser Permanente members will, for the first time ever, be able to easily view the notes charted by their doctor during an office visit,” says Michael McNamara, MD, chief medical information officer for Kaiser Permanente Northwest. “We want patients to feel connected with their providers, and to have the type of tools that will enable them to be more engaged and in control of their care.”

OpenNotes was first piloted as part of a large‑scale research study conducted at Boston’s Beth Israel Deaconess Medical Center, the Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle, which are all now aggressively adopting this practice. In addition, the Veterans Affairs, including the Portland VA Medical Center, since January 2013 has adopted full transparency of clinical note access.

While federal law mandates a patient's right to access their medical records, including clinician notes, obtaining copies of paper records can be time consuming and in some cases, involve costs for the patient. Electronic records provide free, easy access with the click of a button.

“Oregon and Southwest Washington represent the first region in the U.S. to collaborate on implementing open notes as a community,” said Amy Fellows, Director of We Can Do Better. “Local health providers have been very supportive of providing patients here in the Northwest with this increased level of transparency. We look forward to the day when all consumers will be able to access their providers’ notes.”

The use of open notes by groups in the Northwest extends beyond the region. For example, OCHIN, Inc., an Oregon-based nonprofit health information network that operates in 18 states and serves over 2.5 million patients, has enabled its 78 safety net clinics (nearly half in Oregon) to use OpenNotes since December 2013. “I’ve found that open notes is a great way to engage patients in their care,” said Tim Burdick, MD, OCHIN’s chief medical informatics officer and a practicing family physician at OHSU Family Medicine at Scappoose. “When we flipped the switch nationwide for all OCHIN clinics to use open notes, I was pleased with how excited patients and providers were about this approach.”

“With the advent of the electronic health record, it has become much easier to securely share notes among providers and, as a logical extension, with patients,” said Homer Chin, MD, chairperson for the We Can Do Better campaign, the nonprofit, nonpartisan health advocacy organization that is organizing the regional effort. “In light of the many benefits of doing so, it’s time that we engage and empower patients by providing them with easy access to their own medical information.”

Based at Harvard Medical School and Beth Israel Deaconess Medical Center, Tom Delbanco, MD, and Jan Walker, RN, MBA, created and continue to lead the OpenNotes initiative. Dr. Delbanco notes, “This regional collaboration, remarkable both for its nature and the number of patients involved, represents a tremendous step toward engaging patients more actively in their care. In fact, it may prove pivotal in establishing full transparency as the national standard of care.”

The OpenNotes initiative is funded primarily by the Robert Wood Johnson Foundation. It started with a one-year study that examined the impact of offering clinician notes to more than 13,000 patients cared for by 105 primary care doctors at three sites – Beth Israel in Boston, Geisinger Health System in Pennsylvania and Harborview Medical Center in Seattle. The results were strikingly positive: Patients reported feeling more in control of their care, having greater understanding of their medical conditions, and being more likely to take their medications as prescribed. And at the end of a year, 99 percent of patients asked for the practice to continue, while none of the doctors chose to withdraw.

Since 2012, OpenNotes has been spreading throughout the country in small and large health systems, currently affecting until now some 2 million patients. Consumer Reports is working closely with the movement and recently identified OpenNotes as one of the top five innovations in health care in 2013. Major systems implementing this practice now include the Mayo Clinic and the Cleveland Clinic, in addition to Veterans Affairs.

We Can Do Better is being supported to do this work by a grant from the Cambia Health Foundation, which focuses its efforts on supporting ideas and innovations that engage consumers and providers to enhance quality, advance access and promote best practices to help people achieve healthy lives.

About the Robert Wood Johnson Foundation

For more than 40 years the Robert Wood Johnson Foundation has worked to improve the health and health care of all Americans. We are striving to build a national culture of health that will enable all Americans to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.